Liu Michael, Christ Lisa, Richters Anke, Özdemir Berna C
Department of Medical Oncology, Inselspital Bern, Bern University Hospital, University of Bern, CH-3011 Bern, Switzerland.
Department of Rheumatology and Immunology, Inselspital Bern, Bern University Hospital, University of Bern, CH-3011 Bern, Switzerland.
Oncol Lett. 2023 Jul 18;26(3):377. doi: 10.3892/ol.2023.13963. eCollection 2023 Sep.
Female sex is associated with a higher risk for autoimmune diseases (ADs) and immune-related adverse events (irAEs) from immune checkpoint inhibitors (ICIs). While the safety of ICIs in AD cohorts has been reported, sex-segregated data on patient characteristics and outcomes are lacking. In the present study, the disease and treatment characteristics of 51 patients with cancer and preexisting AD (PAD) treated with ICIs at Bern University Hospital Cancer Center (Bern, Switzerland) between January 2017 and June 2021 were analyzed by sex. Rheumatic (n=12/27, 44.4%) and endocrine (n=11/24, 45.8%) PADs were most common among male and female patients, respectively. At the time of ICI initiation, 29.6% (n=8/27) of male and 20.8% (n=5/24) of female patients received immunosuppression for their PAD. Female patients were more likely to experience an irAE (58.3 vs. 48.1%), and less likely to encounter an exacerbation of their PAD (38.5 vs. 14.3%) compared with male patients. Multiple-site irAEs (46.2 vs. 21.4%), implication of an organ specialist for irAEs (100.0 vs. 57.1%) and use of additional immunosuppressive drugs (38.4 vs. 7.7%) were more common in male patients. IrAEs were resolved and ICIs were discontinued in 69.2% (n=9/13) and 71.4% (n=10/14) of the total male and female patients, respectively. Median progression-free survival was higher in male than female patients with irAEs (19.9 vs. 10.7 months) and without irAEs (4.4 vs. 1.8 months). The median overall survival time was higher in male than female patients with irAEs (not estimable vs. 22.5 months) and without irAEs (10.1 vs. 7.4 months). Taken together, these results suggested that sex-related differences existed regarding the clinical presentation of irAEs and treatment outcome.
女性与自身免疫性疾病（ADs）以及免疫检查点抑制剂（ICIs）引发的免疫相关不良事件（irAEs）的较高风险相关。虽然已有关于ICIs在AD队列中的安全性报道，但缺乏按性别分类的患者特征和结局数据。在本研究中，对2017年1月至2021年6月期间在瑞士伯尔尼大学医院癌症中心接受ICIs治疗的51例患有癌症和既往AD（PAD）的患者的疾病和治疗特征进行了性别分析。风湿性（n = 12/27，44.4%）和内分泌性（n = 11/24，45.8%）PAD在男性和女性患者中分别最为常见。在开始使用ICIs时，29.6%（n = 8/27）的男性和20.8%（n = 5/24）的女性患者因PAD接受了免疫抑制治疗。与男性患者相比，女性患者更有可能发生irAE（58.3%对48.1%），而PAD病情加重的可能性较小（38.5%对14.3%）。多部位irAE（46.2%对21.4%）、因irAE请器官专科医生会诊（100.0%对57.1%）以及使用额外的免疫抑制药物（38.4%对7.7%）在男性患者中更为常见。分别有69.2%（n = 9/13）的男性患者和71.4%（n = 10/14）的女性患者的irAE得到缓解且停用了ICIs。有irAE的男性患者的无进展生存期（19.9个月对10.7个月）和无irAE的男性患者（4.4个月对1.8个月）均高于女性患者。有irAE的男性患者的总生存期（不可估计对22.5个月）和无irAE的男性患者（10.1个月对7.4个月）均高于女性患者。综上所述，这些结果表明在irAE的临床表现和治疗结局方面存在性别差异。
